The IntraLase femtosecond laser has had a very positive impact on surgical results in our practice. For economic reasons, success with the laser requires that practices be committed to a comprehensive approach to all-laser LASIK.

THE BOTTOM LINE

Using the IntraLase laser can lower complication and enhancement rates and improve outcomes. The downside to its use is economic: purchasing and operating the laser are both much more expensive than they would be with a microkeratome. As a result, the laser is most appropriate to market-leading practices that are comfortable with high-end pricing and are committed to a comprehensive program of staff education, marketing, and working to optimize the use of such all-laser LASIK technology. Because the laser dissects tissue by means of a highly localized shock wave, it has the potential to induce significant local tissue reaction and inflammation. This can be moderated by having the surgeon be involved in adjusting the key laser paratmeters: lowering the laser stromal bed and side-cut energies, using a preoperative vasoconstrictor, increasing the duration and frequency of topical steroid administration, and chilling the patient's drops.

Ming Wang, MD, PhD, is a clinical associate professor of ophthalmology at the University of Tennessee, staff surgeon at Saint Thomas Hospital and director of Wang Vision Institute, Nashville, TN. He has no financial interest in the product discussed.